Provider Demographics
NPI:1255826343
Name:TASHA CHEMPLAVIL LLC
Entity Type:Organization
Organization Name:TASHA CHEMPLAVIL LLC
Other - Org Name:SMART TALK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEMPLAVIL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:702-339-5475
Mailing Address - Street 1:6624 ANGELINA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2920
Mailing Address - Country:US
Mailing Address - Phone:702-339-5475
Mailing Address - Fax:
Practice Address - Street 1:6624 ANGELINA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2920
Practice Address - Country:US
Practice Address - Phone:702-339-5475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1602261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1669733218Medicaid